1
|
Saoussen A, Sana O, Kaouther H, Hela M, Fatma O. Electocardiographic features in Ebstein's disease. LA TUNISIE MEDICALE 2021; 99:614-622. [PMID: 35244913 PMCID: PMC8795996] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
INTRODUCTION Ebstein's disease (ED) is a rare and heterogeneous congenital heart disease affecting the tricuspid valve and the right ventricle. Few studies have analyzed the electrocardiographic features of this disease. AIM To describe the electrocardiographic features observed in Ebstein's disease. METHODS We conducted a retrospective descriptive study that enrolled 26 patients followed for ED. RESULTS The mean age of discovery of the ME was 103.5±99 months [0-31 years]. The diagnosis of ME is most often made between 5 and 10 years. We noted right atrial hypertrophy in 11 patients (42%), right ventricular hypertrophy in half of the patients. Right axial deviation was noted in 11 patients (42%). Eight patients (30%) had wide QRS≥ 120 ms. Seven of these 8 patients (27%) had a fragmented QRS appearance. A right bandle block was noted in 22 patients (84%), it was a complete block in 7 cases (27%). A preexcitation was found in 6 patients (23%). The localization of accessory pathway was right postero-septal in all cases. Rhythmic disorders were noted in 9 patients (34%). It was a junctional tachycardia in 3 patients (11%), atrial flutter in 4 patients (15%) and atrial fibrillation in 2 patients (7%). A second degree atriventricular block was observed in one patient, it was Mobitz I type. Two cases of postoperative rhythm disturbances were recorded: paroxysmal atrial fibrillation and junctional tachycardia related to Wolf Parkinson White (WPW) syndrome. CONCLUSION Surface ECG in the ED is often pathological with prevalence of rhythm disturbances related to WPW syndrome.
Collapse
|
2
|
Namazi MH, Safi M, Momenizadeh A, Khaheshi I, Memaryan M, Movahed MR. Mahaim fibers coexisting with coarctation of aorta and bicuspid aortic valve. Future Cardiol 2018; 14:483-489. [PMID: 30421621 DOI: 10.2217/fca-2017-0093] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
We found a coexistence of Mahaim fibers, coarctation of aorta and bicuspid valve in a young patient presenting with palpitations and subraventricular tachycardia. This rare combination of these three congenital cardiac abnormalities occurring in the same patient has not been reported previously. Detailed cardiac studies unmasked the patient's cardiac abnormalities. Furthermore, successful percutaneous intervention in treating coarctation and catheter-based ablation of Mahaim fibers were performed with resolution of symptoms. This case is discussed here in detail, alongside a review of the literature.
Collapse
Affiliation(s)
- Mohammad H Namazi
- Cardiovascular Research Center, Modarres Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Morteza Safi
- Cardiovascular Research Center, Modarres Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Amir Momenizadeh
- Cardiovascular Research Center, Modarres Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Isa Khaheshi
- Cardiovascular Research Center, Modarres Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mehdi Memaryan
- Cardiovascular Research Center, Modarres Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mohammad R Movahed
- Department of Medicine, University of Arizona, School of Medicine, Tucson, Arizona, USA.,Care More Health, 7901 E Speedway, Tucson, Arizona, AZ 85710, USA
| |
Collapse
|
3
|
Ross FJ, Latham GJ, Richards M, Geiduschek J, Thompson D, Joffe D. Perioperative and Anesthetic Considerations in Ebstein’s Anomaly. Semin Cardiothorac Vasc Anesth 2015; 20:82-92. [DOI: 10.1177/1089253215605390] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Ebstein’s anomaly is a complex and heterogeneous form of congenital heart disease characterized by malformation and apical displacement of the tricuspid valve leaflets. Patients may present at any time from the neonatal period to adulthood with symptoms ranging from cardiac failure and cyanosis to paroxysmal arrhythmias. Depending on the timing of presentation, various surgical options are available for the management of symptomatic patients. This review will discuss the perioperative and anesthetic management of patients with Ebstein’s anomaly with reference to the more common surgical approaches.
Collapse
Affiliation(s)
- Faith J. Ross
- Seattle Children’s Hospital, University of Washington School of Medicine, Seattle, WA, USA
| | - Gregory J. Latham
- Seattle Children’s Hospital, University of Washington School of Medicine, Seattle, WA, USA
| | - Michael Richards
- Seattle Children’s Hospital, University of Washington School of Medicine, Seattle, WA, USA
| | - Jeremy Geiduschek
- Seattle Children’s Hospital, University of Washington School of Medicine, Seattle, WA, USA
| | - Douglas Thompson
- Seattle Children’s Hospital, University of Washington School of Medicine, Seattle, WA, USA
| | - Denise Joffe
- Seattle Children’s Hospital, University of Washington School of Medicine, Seattle, WA, USA
| |
Collapse
|
4
|
GUO XIAOGANG, LIU XU, ZHOU GONGBU, MA JIAN, OUYANG FEIFAN, ZHANG SHU. Frequency of Fractionated Ventricular Activation and Atrial/Ventricular Electrogram Amplitude Ratio at Successful Ablation Target of Accessory Pathways in Patients with Ebstein's Anomaly. J Cardiovasc Electrophysiol 2015; 26:404-411. [DOI: 10.1111/jce.12607] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2014] [Revised: 12/12/2014] [Accepted: 12/14/2014] [Indexed: 11/26/2022]
Affiliation(s)
- XIAO-GANG GUO
- State Key Laboratory of Cardiovascular Disease, Arrhythmia Center, Fuwai Hospital, National Center for Cardiovascular Diseases; Chinese Academy of Medical Sciences and Peking Union Medical College; Beijing China
| | - XU LIU
- State Key Laboratory of Cardiovascular Disease, Arrhythmia Center, Fuwai Hospital, National Center for Cardiovascular Diseases; Chinese Academy of Medical Sciences and Peking Union Medical College; Beijing China
| | - GONG-BU ZHOU
- State Key Laboratory of Cardiovascular Disease, Arrhythmia Center, Fuwai Hospital, National Center for Cardiovascular Diseases; Chinese Academy of Medical Sciences and Peking Union Medical College; Beijing China
| | - JIAN MA
- State Key Laboratory of Cardiovascular Disease, Arrhythmia Center, Fuwai Hospital, National Center for Cardiovascular Diseases; Chinese Academy of Medical Sciences and Peking Union Medical College; Beijing China
| | - FEIFAN OUYANG
- Department of Cardiology; Asklepios Klinik St. Georg; Hamburg Germany
| | - SHU ZHANG
- State Key Laboratory of Cardiovascular Disease, Arrhythmia Center, Fuwai Hospital, National Center for Cardiovascular Diseases; Chinese Academy of Medical Sciences and Peking Union Medical College; Beijing China
| |
Collapse
|
5
|
Hafez M, Abu-Elkheir M, Shokier M, Al-Marsafawy H, Abo-Haded H, El-Maaty MA. Radiofrequency catheter ablation in children with supraventricular tachycardias: intermediate term follow up results. CLINICAL MEDICINE INSIGHTS-CARDIOLOGY 2012; 6:7-16. [PMID: 22259261 PMCID: PMC3256955 DOI: 10.4137/cmc.s8578] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
The Purpose of the Study Radiofrequency (RF) catheter ablation represents an important advance in the management of children with cardiac arrhythmias and has rapidly become the standard and effective line of therapy for supraventricular tachycardias (SVTs) in pediatrics. The purpose of this study was to evaluate the intermediate term follow up results of radiofrequency catheter ablation in treatment of SVT in pediatric age group. Methods A total of 60 pediatric patients (mean age = 12.4 ± 5.3 years, ranged from 3 years to 18 years; male: female = 37:23; mean body weight was 32.02 ± 12.3 kg, ranged from 14 kg to 60 kg) with clinically documented SVT underwent an electrophysiologic study (EPS) and RF catheter ablation at Children’s Hospital Mansoura University, Mansoura, Egypt during the period from January 2008 to December 2009 and they were followed up until October 2011. Results The arrhythmias included atrioventricular reentrant tachycardia (AVRT; n = 45, 75%), atrioventricular nodal reentrant tachycardia (AVNRT; n = 6, 10%), and atrial tachycardia (AT; n = 9, 15%). The success rate of the RF catheter ablation was 93.3% for AVRT, 66.7% for AVNRT, and 77.8% for AT, respectively. Procedure-related complications were infrequent (7/60, 11.7%), (atrial flutter during RF catheter ablation (4/60, 6.6%); ventricular fibrillation during RF catheter ablation (1/60, 1.6%); transient complete heart block during RF catheter ablation (2/60, 3.3%)). The recurrence rate was 8.3% (5/60) during a follow-up period of 34 ± 12 months. Conclusion RF catheter ablation is an effective and safe method to manage children with SVT.
Collapse
Affiliation(s)
- Mm Hafez
- Pediatric Cardiology Unit, Department of Pediatrics, Faculty of Medicine, Mansoura University, Mansoura, Egypt
| | | | | | | | | | | |
Collapse
|
6
|
Lee PC, Hwang B, Chen SA, Tai CGT, Chen YJ, Chiang CE, Meng CCL. The Results of Radiofrequency Catheter Ablation of Supraventricular Tachycardia in Children. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2007; 30:655-61. [PMID: 17461876 DOI: 10.1111/j.1540-8159.2007.00727.x] [Citation(s) in RCA: 46] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND Radiofrequency (RF) catheter ablation represents a major advance in the management of children with cardiac arrhythmias and has rapidly become the standard of care for the first-ling therapy of supraventricular tachycardias (SVTs). The purpose of this study was to investigate the results of the RF catheter ablation of SVTs in pediatric patients. METHODS From December 1989 to August 2005, a total of 228 pediatric patients (age: 9 +/- 7 years, range: 5-18 years; male:female = 117:111) with clinically documented SVT underwent an electrophysiologic study and RF catheter ablation at our institution. RESULTS The arrhythmias included atrioventricular reentrant tachycardia (AVRT; n = 140, 61%), atrioventricular nodal reentrant tachycardia (AVNRT; n = 66, 29%), atrial tachycardia (AT; n = 11, 5%), and atrial flutter (AFL; n = 11, 5%). The success rate of the RF catheter ablation was 92% for AVRT, 97% for AVNRT, 82% for AT, and 91% for AFL, respectively. Procedure-related complications were infrequent (8.7%; major complications: high grade AV block (2/231, 0.9%); minor complications: first degree AV block (6/231, 2.6%), reversible brachial plexus injury (2/231, 0.9%), and local hematomas or bruises (10/231, 4.3%)). The recurrence rate was 4.7% (10/212) during a follow-up period of 86 +/- 38 months (0.5-185 months). CONCLUSIONS The RF catheter ablation was a safe and effective method to manage children with paroxysmal and incessant tachycardia. The substrates of the arrhythmias differed between the pediatric and adult patients. However, the success rate of the ablation, complications, and recurrence during childhood were similar to those of adults.
Collapse
Affiliation(s)
- Pi-Chang Lee
- Department of Pediatrics, Taipei Veterans General Hospital and National Yang-Ming University, Taipei, Taiwan.
| | | | | | | | | | | | | |
Collapse
|
7
|
Khositseth A, Danielson GK, Dearani JA, Munger TM, Porter CJ. Supraventricular tachyarrhythmias in Ebstein anomaly: management and outcome. J Thorac Cardiovasc Surg 2004; 128:826-33. [PMID: 15573066 DOI: 10.1016/j.jtcvs.2004.02.012] [Citation(s) in RCA: 94] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
OBJECTIVE This study was undertaken to review the role of electrophysiology testing and to determine the early and late results of medical and surgical management of supraventricular tachyarrhythmias in Ebstein anomaly. METHODS We reviewed 130 patients between 1990 and 2001 with Ebstein anomaly and history of tachyarrhythmia with a median age of 25 years (mean age 27.5 years); 106 underwent electrophysiologic testing and 24 had documented atrial flutter or fibrillation. We excluded 21 patients: negative results of testing (n = 18), ventricular tachycardia (n = 2), and junctional tachycardia (n = 1). The remaining 109 patients had more than one mechanism: accessory pathway-mediated tachycardia (n = 49), atrioventricular nodal reentrant tachycardia (n = 10), and atrial flutter/fibrillation (n = 70). RESULTS Eighty-three patients underwent at least one arrhythmia procedure combined with surgery for Ebstein anomaly. Early mortality was 4.8%. Forty-one patients underwent surgical ablation of an accessory pathway without recurrent accessory pathway-mediated tachycardia at a mean follow-up of 48 months. Seven patients underwent surgical perinodal cryoablation for atrioventricular nodal reentrant tachycardia without recurrence at a mean follow-up of 57 months. Forty-eight patients underwent surgical intervention for atrial flutter or fibrillation (right-sided maze procedure, n = 38, and cryoablation of the atrial isthmus, n = 10). Freedom from recurrent atrial flutter or fibrillation was 75% at a mean follow-up of 34 months. CONCLUSION Concomitant arrhythmia procedures can be performed without increase in early mortality and should be added to Ebstein repairs for all patients who have supraventricular tachyarrhythmias. Surgical procedures for accessory pathway-mediated tachycardia and atrioventricular nodal reentrant tachycardia give excellent (100%) freedom from recurrence of those arrhythmias. Surgical intervention for atrial flutter/fibrillation yields freedom from late recurrence in 75% of cases.
Collapse
Affiliation(s)
- Anant Khositseth
- Department of Pediatric and Adolescent Medicine, Division of Pediatric Cardiology, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA
| | | | | | | | | |
Collapse
|
8
|
Mani H, Shirayama T, Yamamura M, Sakamoto T, Yoshida A, Nakagawa M. Ebstein Anomaly Associated With Unusual Conduction Delay and Sick Sinus Syndrome-A Case Report-. Circ J 2004; 68:719-21. [PMID: 15226641 DOI: 10.1253/circj.68.719] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
A 64-year-old man was admitted to our hospital because of palpitation, dyspnea on effort, and facial edema. The echocardiographic diagnosis was Ebstein anomaly. Although the 12-lead electrocardiogram showed an atrial rate of 150 beats/min and no typical flutter wave, the electrophysiological study showed counterclockwise rotation of excitation along the tricuspid annulus. Because of sinus arrest and syncope, a permanent pacemaker was implanted, but the right atrium was not captured by electrical stimulation at 5 V/0.4 ms, except for the orifice of coronary sinus, and the intracardiac P wave was only 0.2 mV or less. This is a rare case of Ebstein anomaly characterized by unusually prolonged conduction in the atrium, the basis of which was global myocardial damage, including the ventricles.
Collapse
Affiliation(s)
- Hiroki Mani
- Second Department of Medicine, Kyoto Prefectural University of Medicine, Kyoto, Japan.
| | | | | | | | | | | |
Collapse
|
9
|
Ho SY, Goltz D, McCarthy K, Cook AC, Connell MG, Smith A, Anderson RH. The atrioventricular junctions in Ebstein malformation. Heart 2000; 83:444-9. [PMID: 10722549 PMCID: PMC1729380 DOI: 10.1136/heart.83.4.444] [Citation(s) in RCA: 71] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVE To review the anatomical structure of the right atrioventricular junction, including the specialised atrioventricular conduction system, in hearts with Ebstein's malformation, to identify potential substrates for the abnormalities in conduction. METHODS Five heart specimens representing the morphological spectrum of Ebstein malformation were examined grossly and histologically. RESULTS On the endocardial surface, the atrioventricular junction was marked by a faint line in two hearts, and by a small ridge in the other three. Analysis of the right parietal junction in four hearts revealed only two accessory muscular atrioventricular connections. A plane of fibrofatty tissue separated atrial from ventricular myocardium in the right parietal junction in all hearts. The compact atrioventricular node was closer to the coronary sinus than usual. Accessory nodoventricular connections were present in four hearts, while accessory fasciculo-ventricular connections were found in one. The right bundle branch was hypoplastic or absent in four hearts. CONCLUSIONS In this small series, the parietal atrioventricular junction was better developed than previously thought. Structural abnormalities of the atrioventricular conduction system, however, were present. These may account for some of the conduction abnormalities frequently observed with the Ebstein malformation.
Collapse
Affiliation(s)
- S Y Ho
- Paediatrics, National Heart and Lung Institute, Royal Brompton Campus, Imperial College of Science, Technology and Medicine, Dovehouse Street, London SW3 6LY, UK.
| | | | | | | | | | | | | |
Collapse
|
10
|
Abstract
Ebstein's malformation of the tricuspid valve is a complex and heterogeneous disorder that has diverse hemodynamic and arrhythmic manifestations. Hemodynamic dysfunction is due to valvar regurgitation and decreased pulmonary blood flow, varying in severity from mild tricuspid insufficiency to severe dysplasia of the right ventricle without forward flow. Atrioventricular reentrant tachycardia and atrial tachyarrhythmias are commonly associated with Ebstein's malformation. Treatment ranges from conservative medical management to the ablation of pathways by catheterization to complex surgical repair or palliation. All patients with Ebstein's malformation should be followed on a regular basis by a cardiologist familiar with congenital heart disease. The frequency of evaluations should depend on the severity of the disease and the presence of arrhythmias. A specialist in electrophysiology should also follow those patients with complex arrhythmias.
Collapse
Affiliation(s)
- AK Younoszai
- Pediatric Cardiology Box 0544, 505 Parnassus Ave., Room HSE 1403, University of California at San Francisco, San Francisco, CA 94143, USA
| | | | | |
Collapse
|